Thoracic Oncology

Lung cancer kills about 150,000 Americans each year. But when it is detected early, survival rates improve exponentially. UConn Health is the first hospital in New England to use a new robotic technology to diagnose cancer sooner, getting patients the treatment they need and saving lives.

Supporters of U.S. Supreme Court Justice Ruth Bader Ginsburg breathed a collective sigh of relief this winter after two cancerous nodules were successfully removed from her left lung through a lobectomy. Ginsburg’s cancer was found during the routine testing done after the fit 85-year-old fractured several ribs in a fall, and for a moment the diagnosis cracked the seemingly invincible façade of the octogenarian icon.

Although Ginsburg’s cancer was found by chance, her story is a great example of how early detection and swift action can improve the likelihood of survival for lung cancer, the deadliest cancer for both men and women in the U.S. by a wide margin. More people die of lung cancer each year than of colon, breast, and prostate cancers combined, and more than half of people with lung cancer die within a year of being diagnosed, according to the American Lung Association.

“The accuracy of this is going to pan out to be second to none. I think this is the tip of the iceberg in diagnosis.”

But when the cancer is detected early, before it spreads beyond the lungs, the five-year survival rate jumps from 5 percent to 56 percent. The problem is, just 16 percent of lung cancer diagnoses come at an early stage, American Lung Association statistics show. Since lung cancer is the second most common cancer in both men and women, proper screening for those at risk could save tens of thousands of lives.

A revolutionary precision technology now at UConn Health is making early diagnosis easier than ever.

UConn Health is the first hospital in New England and among the first in the nation to offer robotic bronchoscopy on the Monarch platform from Auris Health, allowing physicians to quickly diagnose lesions detected through low-dose CT scans, including those that are small or in hard-to-reach parts of the lung.

“Before this technology, the targets would’ve had to be bigger. I wouldn’t be able to make certain angles without the robotic arm to navigate,” says Dr. Omar Ibrahim, UConn Health director of thoracic oncology and interventional pulmonology. “I have a higher degree of confidence and accuracy with this than with prior equipment.

“The ability to diagnose the cancers at an earlier stage will allow us to surgically manage the disease,” he says. “This is the only chance for a cure.”

The Monarch platform’s advanced, precision endoscope allows physicians to access hard-to-reach parts of the lungs and their bronchi and to diagnose lesions earlier than ever before.

With its user-friendly, video-game-style controller, the Monarch platform allows the physician to move the endoscope up and down, left and right, forward and backward through a lung and its bronchi. Buttons on the controller make the scope of view bigger or smaller, while others control suction or irrigation. Procedures are done in the operating room under general anesthesia. Within about an hour, the doctor will biopsy the suspicious nodule and a lymph node for analysis by a pathologist. The patient can go home the same day.

If cancer is confirmed in the lung, it will then be staged to see how far it has advanced. A team of cancer specialists then develop an individualized treatment plan that is ideal for the patient and their specific type and stage of cancer. A patient’s treatment plan might include surgery to remove a small portion of the lung or the entire lung, radiation therapy, chemotherapy, medications,
and immunotherapy.

“We have had patients where initial and subsequent biopsies are inconclusive. A decision then has to be made: remove the nodule surgically, or watch it for growth,” Thibodeau says.

“This can be stressful on a patient. They either have to go through a significant procedure they may not have needed or wait to see if the nodule gets worse. This technology will give us better accuracy for appropriate tissue sampling, making the decision more clear.”

A revolutionary precision technology is making early diagnosis easier than ever.

Routine screenings of high-risk patients — those with histories of smoking, especially — using low-dose CT scans and minimally invasive techniques help detect lesions and diagnose more people all the time.
The Monarch platform is the next step in improving outcomes for lung cancer patients, and Ibrahim sees even more groundbreaking advances on the horizon.

“Within the next year or two, this technology should allow us to treat lesions with radiofrequency ablation [a minimally invasive procedure that uses heat to destroy cancer cells],” Ibrahim says. “Diagnosis and treatment could be done all at the same time.”

In his time at UConn Health, Ibrahim has worked to improve the experience of UConn Health’s lung cancer patients, particularly through a multidisciplinary team that allows patients to come to one clinic to see a variety of doctors.

“Since we’ve enhanced and personalized the way we care for lung cancer, the number of lung cancer patients at UConn Health has quickly increased,” says Ibrahim. “Time to diagnosis and treatment is tremendously shorter, and patients are happier with the quality of their care.”

He believes the robotic bronchoscopy technology will allow the team to deliver even better results.

“The accuracy of this is going to pan out to be second to none,” says Ibrahim. “I think this is the tip of the iceberg in diagnosis, and the therapeutic aspect of it, which will evolve over time, is really exciting. Being at the forefront of that is amazing.”

As director of thoracic oncology and interventional pulmonology at UConn Health, Dr. Omar Ibrahim has been working hard to personalize and improve the experience of lung cancer patients.

“As a result of enhancing individualized care, the number of lung cancer patients UConn Health cares for has been rapidly increasing,” says Ibrahim. “We have immensely improved a patient’s time to diagnosis and treatment, as well as the overall quality of care they receive. Plus, our program’s advanced diagnostic imaging and rapid-sequence genetic testing has allowed us to get patients proper therapy in the most effective way possible.”

According to Ibrahim, UConn Health is one of a few institutions in the Northeast to consolidate how they care for lung cancer patients.

“Rather than having patients visit multiple physicians in different locations on our campus, we focus all our care for lung cancer patients in one multidisciplinary clinic,” says Ibrahim, who led the specialized clinic’s development. “This allows for ease of care and greater patient satisfaction and increases the patient’s knowledge.”

We have immensely improved a patient’s time to diagnosis and treatment, as well as the overall quality of care they receive.

The biggest risk factor for lung cancer, which kills more Americans than breast, colon, and prostate cancers combined, is smoking. Ibrahim passionately urges current and former heavy smokers to get screened for the disease with a low-dose computed tomography (CT) scan at UConn Health’s Lung Cancer Screening Program at the Carole and Ray Neag Comprehensive Cancer Center.

“Our goal is to find lung cancer at its earliest stage so we can have options to treat it and cure it,” Ibrahim says.

If a low-dose CT scan catches a suspicious lung nodule or growth, Ibrahim leverages minimally invasive techniques to rule out lung cancer, or diagnose and identify what stage the disease is at. He uses video-guided 3-D navigational bronchoscopy technology and ultrasound in the exam room to closely examine a patient’s lung tissue using a thin, flexible tube via the nose or mouth. The technology also allows for small lung tissue biopsy samples to be taken.

But Ibrahim is not only proud of improving his patient’s experience and outcomes.

“What I am truly proud of is the team effort of everyone involved with a lung cancer patient’s care, from the staffer greeting them at the door to the nurse infusing their chemotherapy. They all are doing an immense job.”